{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:45:35Z","timestamp":1787755535034,"version":"build-2784847793"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Case:<\/jats:title>\n                    <jats:p>A 6-year-old patient with Ewing sarcoma at L4 who was treated with total en bloc spondilectomy (TES) through a posterior-only approach. During the dissection of the anterior L4 body, there was uncontrollable bleeding from an unknown origin, which needed packing, massive transfusion, and urgent laparotomy. A median sacral artery (MSA) rupture was identified as the cause of this massive bleeding. Eventually, the patient was successfully stabilized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>To our knowledge, this is the first reported intraoperative bleeding of the MSA related to a lumbar TES through posterior-only approach. This life-threatening complication should be considered when planning for this type of surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.cc.19.00427","type":"journal-article","created":{"date-parts":[[2020,7,7]],"date-time":"2020-07-07T22:02:25Z","timestamp":1594159345000},"page":"e19.00427-e19.00427","source":"Crossref","is-referenced-by-count":0,"title":["Median Sacral Artery Rupture as a Complication of Posterior-Only Approach of L4 Total En Bloc Spondilectomy"],"prefix":"10.2106","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3034-8959","authenticated-orcid":false,"given":"Beatriz","family":"Garcia-Maya","sequence":"first","affiliation":[{"name":"Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7394-9637","authenticated-orcid":false,"given":"Javier","family":"Pizones","sequence":"additional","affiliation":[{"name":"Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0306-4726","authenticated-orcid":false,"given":"Jose Miguel","family":"Sanchez-Marquez","sequence":"additional","affiliation":[{"name":"Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6199-1264","authenticated-orcid":false,"given":"Gloria","family":"Talavera","sequence":"additional","affiliation":[{"name":"Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2962-5322","authenticated-orcid":false,"given":"Francisco Javier","family":"Perez-Grueso","sequence":"additional","affiliation":[{"name":"Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6207-1934","authenticated-orcid":false,"given":"Nicomedes","family":"Fernandez-Baillo","sequence":"additional","affiliation":[{"name":"Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020]]},"reference":[{"key":"bib1-20230720","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1634\/theoncologist.11-5-503","article-title":"Ewing's sarcoma family of tumours: current managment","volume":"1","author":"Bernstein","year":"2006","journal-title":"Oncologist."},{"key":"bib2-20230720","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1002\/cncr.29065","article-title":"Comparative evaluation of local control strategies in localized Ewing sarcoma of bone: a report from the Children's Oncology Group","volume":"121","author":"DuBois","year":"2015","journal-title":"Cancer."},{"key":"bib3-20230720","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1179\/1743132814Y.0000000369","article-title":"En bloc resection of primary tumors of the thoracic spine: indications, planning, morbidity","volume":"36","author":"Boriani","year":"2014","journal-title":"Neurol Res."},{"key":"bib4-20230720","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1097\/00007632-199702010-00018","article-title":"Total en bloc spondylectomy. 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